Provider First Line Business Practice Location Address:
2223 CENTRAL AVE NE STE 1
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:
55418-3354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-782-0173
Provider Business Practice Location Address Fax Number:
612-782-0196
Provider Enumeration Date:
09/27/2006