Provider First Line Business Practice Location Address:
5313 LYNDALE AVE S
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:
55419-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-822-0149
Provider Business Practice Location Address Fax Number:
812-822-7441
Provider Enumeration Date:
11/06/2006