Provider First Line Business Practice Location Address:
FAIRVIEW CLINICS-BASS LAKE
Provider Second Line Business Practice Location Address:
6320 WEDGWOOD RD N
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55311-3647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-268-0400
Provider Business Practice Location Address Fax Number:
763-268-0405
Provider Enumeration Date:
02/17/2009