Provider First Line Business Practice Location Address:
400 S FOURTH ST
Provider Second Line Business Practice Location Address:
#201 METROPOLITAN HEALTH PLAN
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-347-8557
Provider Business Practice Location Address Fax Number:
612-904-4265
Provider Enumeration Date:
11/21/2006