Provider First Line Business Practice Location Address:
1720 UNIVERSITY DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-4940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-4171
Provider Business Practice Location Address Fax Number:
701-461-5649
Provider Enumeration Date:
07/17/2006