Provider First Line Business Practice Location Address:
410 CHURCH STREET S.E.-UNIVERSITY OF MINNESOTA
Provider Second Line Business Practice Location Address:
MENTAL HEALTH CLINIC-4TH FLOOR
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:
612-803-8442
Provider Business Practice Location Address Fax Number:
612-626-7155
Provider Enumeration Date:
03/27/2007