Provider First Line Business Practice Location Address: 
UNIVERSITY OF MINNESOTA PHYSICIANS
    Provider Second Line Business Practice Location Address: 
606 24TH AVE S, SUITE 300
    Provider Business Practice Location Address City Name: 
MINNEAPOLIS
    Provider Business Practice Location Address State Name: 
MN
    Provider Business Practice Location Address Postal Code: 
55455-5545
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
612-273-7111
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/19/2006