Provider First Line Business Practice Location Address:
516 DELAWARE ST SE
Provider Second Line Business Practice Location Address:
CLINIC 2A
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-626-1687
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2008