Provider First Line Business Practice Location Address:
1351 FROST AVENUE
Provider Second Line Business Practice Location Address:
SENIOR RECOVERY PROGRAM
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-773-0473
Provider Business Practice Location Address Fax Number:
651-773-9298
Provider Enumeration Date:
12/03/2008