Provider First Line Business Practice Location Address:
PARK NICOLLET CLINIC IDC
Provider Second Line Business Practice Location Address:
3800 PARK NICOLLET BLVD
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-3393
Provider Business Practice Location Address Fax Number:
952-993-1302
Provider Enumeration Date:
12/16/2005