Provider First Line Business Practice Location Address:
6401 FRANCE AVE S
Provider Second Line Business Practice Location Address:
FAIRVIEW SOUTHDALE HOSPITAL
Provider Business Practice Location Address City Name:
EDINA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-924-8463
Provider Business Practice Location Address Fax Number:
952-924-8358
Provider Enumeration Date:
06/19/2008