Provider First Line Business Practice Location Address:
12900 JOHNNY CAKE RIDGE ROAD
Provider Second Line Business Practice Location Address:
ATT: SPECIAL EDUCATION
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124-5092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-431-8793
Provider Business Practice Location Address Fax Number:
952-431-8791
Provider Enumeration Date:
03/07/2007