Provider First Line Business Practice Location Address:
2545 CHICAGO AVE S
Provider Second Line Business Practice Location Address:
STE 510
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-285-6879
Provider Business Practice Location Address Fax Number:
952-285-6890
Provider Enumeration Date:
06/28/2005