Provider First Line Business Practice Location Address:
250 SO 4TH ST ROOM 510
Provider Second Line Business Practice Location Address:
MPLS DEPT OF HEALTH & FAMILY SUPPORT SCHOOL BASED CLIN
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-673-5305
Provider Business Practice Location Address Fax Number:
612-673-3866
Provider Enumeration Date:
11/30/2006