Provider First Line Business Practice Location Address:
12220 282ND AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZIMMERMAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55398-4619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-467-1100
Provider Business Practice Location Address Fax Number:
612-713-6728
Provider Enumeration Date:
02/11/2026