Provider First Line Business Practice Location Address:
6490 EXCELSIOR BOULEVARD
Provider Second Line Business Practice Location Address:
MINNESOTA ORTHOPEDICS PA STE W417 MEADOWBROOK MED BLDG
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:
55426-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-925-2388
Provider Business Practice Location Address Fax Number:
952-925-0743
Provider Enumeration Date:
06/09/2006