Provider First Line Business Practice Location Address:
5200 FAIRVIEW BOULEVARD
Provider Second Line Business Practice Location Address:
FAIRVIEW SPORTS AND ORTHOPEDIC CARE
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-982-7495
Provider Business Practice Location Address Fax Number:
651-982-7539
Provider Enumeration Date:
10/29/2008