Provider First Line Business Practice Location Address:
2219 OAKLAND 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:
55404-3749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-874-1936
Provider Business Practice Location Address Fax Number:
612-874-6516
Provider Enumeration Date:
10/22/2008