Provider First Line Business Practice Location Address:
5100 GAMBLE DR SUITE 100
Provider Second Line Business Practice Location Address:
MAIL STOP31200A, HEALTH PARTNERS WEST CLINIC
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:
55416-1582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-541-2500
Provider Business Practice Location Address Fax Number:
952-595-6455
Provider Enumeration Date:
06/21/2008