Provider First Line Business Practice Location Address:
2312 SOUTH 6TH ST
Provider Second Line Business Practice Location Address:
SUITE F256 / 2B W U OF M PHYSICIANS
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-273-9800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2006