Provider First Line Business Practice Location Address:
2101 UNIVERSITY DR 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:
58102-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-237-9073
Provider Business Practice Location Address Fax Number:
701-297-3077
Provider Enumeration Date:
05/11/2006