Provider First Line Business Practice Location Address:
3120 25TH ST S STE P
Provider Second Line Business Practice Location Address:
SOUTHPOINTE MALL
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-232-4972
Provider Business Practice Location Address Fax Number:
701-232-4972
Provider Enumeration Date:
01/24/2014