Provider First Line Business Practice Location Address:
2101 ELM STREET N
Provider Second Line Business Practice Location Address:
PATHOLOGY 113
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-239-3700
Provider Business Practice Location Address Fax Number:
701-237-2680
Provider Enumeration Date:
08/17/2007