Provider First Line Business Practice Location Address:
3640 ZENITH AVE S
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:
55410-1165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-920-2252
Provider Business Practice Location Address Fax Number:
612-924-4148
Provider Enumeration Date:
08/31/2006