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FARGO, ND
NPI1568771608
Entity TypeOrganization
Authorized ContactTERI LISBURG
O PT Ician/Manager
701-298-0643
Organization Subpart ?No
Primary Taxonomy332H00000X Eyewear Supplier
Enumeration Date2010-10-06
Last Update Date2010-10-06
Business Address
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4344 20TH AVE SW
FARGO, ND 58103-7436
Phone number: 701-298-0643
Mailing Address
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4344 20TH AVE SW
FARGO, ND 58103-7436
Phone number: 701-298-0643