Provider First Line Business Practice Location Address:
516 DELWARE ST SE PWB CLINIC 2A
Provider Second Line Business Practice Location Address:
UNIVERSITY OF MINNESOTA PHYSICIANS
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455-0356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-624-9444
Provider Business Practice Location Address Fax Number:
612-626-3840
Provider Enumeration Date:
12/28/2005