Provider First Line Business Practice Location Address:
16372 KENRICK AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100 LAKEVILLE INTEGRATIVE MEDICINE CLINIC
Provider Business Practice Location Address City Name:
LAKEVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-892-6700
Provider Business Practice Location Address Fax Number:
952-892-9475
Provider Enumeration Date:
06/07/2006