Provider First Line Business Practice Location Address:
401 PHALEN BLVD - MS 41104A
Provider Second Line Business Practice Location Address:
HEALTHPARTNERS SPECIALTY CENTER 401
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55130-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-254-7980
Provider Business Practice Location Address Fax Number:
651-254-7969
Provider Enumeration Date:
04/17/2009