Provider First Line Business Practice Location Address:
825 S 8TH ST
Provider Second Line Business Practice Location Address:
PARKSIDE PROFESSIONAL BLDG., STE 600
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404-1208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-339-7171
Provider Business Practice Location Address Fax Number:
612-339-2885
Provider Enumeration Date:
07/20/2005