Provider First Line Business Practice Location Address: 
2450 RIVERSIDE AVE
    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: 
55454-1450
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
612-672-6000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
10/31/2006