Provider First Line Business Practice Location Address:
2139 44TH AVE N
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:
55412-1162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-521-5275
Provider Business Practice Location Address Fax Number:
612-353-6706
Provider Enumeration Date:
12/19/2008