Provider First Line Business Practice Location Address:
800 E 28TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-871-7639
Provider Business Practice Location Address Fax Number:
612-872-0302
Provider Enumeration Date:
09/25/2006