Provider First Line Business Practice Location Address:
229 13TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55413-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-623-3309
Provider Business Practice Location Address Fax Number:
612-623-3319
Provider Enumeration Date:
12/20/2011