Provider First Line Business Practice Location Address:
1315 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:
58103-4144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-237-3030
Provider Business Practice Location Address Fax Number:
701-237-4296
Provider Enumeration Date:
06/11/2006