Provider First Line Business Practice Location Address:
2102 ELM STR NORTH
Provider Second Line Business Practice Location Address:
DEPT OF VETERANS AFFAIRS MEDICAL CENTER
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58102-2498
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:
Provider Enumeration Date:
07/30/2008