Provider First Line Business Practice Location Address:
4143 MINNEHAHA AVE
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:
55406-3339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-824-4163
Provider Business Practice Location Address Fax Number:
612-724-4857
Provider Enumeration Date:
02/05/2007