Provider First Line Business Practice Location Address:
149 8TH AVE NE
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:
55413-2782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-478-6710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2026