Provider First Line Business Practice Location Address:
2301 25TH ST S
Provider Second Line Business Practice Location Address:
STE K
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-6104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-234-1728
Provider Business Practice Location Address Fax Number:
701-234-1628
Provider Enumeration Date:
05/10/2006