Provider First Line Business Practice Location Address:
1360 10TH ST N
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:
58102-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-237-5517
Provider Business Practice Location Address Fax Number:
701-237-3262
Provider Enumeration Date:
08/10/2005