Provider First Line Business Practice Location Address:
2101 ELM ST.
Provider Second Line Business Practice Location Address:
VA 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-239-3756
Provider Business Practice Location Address Fax Number:
701-239-2462
Provider Enumeration Date:
07/10/2006