Provider First Line Business Practice Location Address:
310 SMITH AVE N
Provider Second Line Business Practice Location Address:
SUITE 120, CHILDRENS SPECIALTY CLINIC-ORTHOPAEDICS-STPL
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-220-5705
Provider Business Practice Location Address Fax Number:
651-220-5040
Provider Enumeration Date:
08/16/2005