Provider First Line Business Practice Location Address:
1222 2ND ST NE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55413-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-378-3220
Provider Business Practice Location Address Fax Number:
612-378-3225
Provider Enumeration Date:
06/06/2011