Provider First Line Business Practice Location Address:
2545 CHICAGO AVENUE SOUTH
Provider Second Line Business Practice Location Address:
MOB BUILDING, 7TH FLOOR
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-863-4471
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2005