Provider First Line Business Practice Location Address:
227 COLFAX AVE N
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55405-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-759-8789
Provider Business Practice Location Address Fax Number:
612-823-3869
Provider Enumeration Date:
01/07/2007