Provider First Line Business Practice Location Address:
2525 CHICAGO AVENUE SOUTH
Provider Second Line Business Practice Location Address:
CHILDRENS SPECIALTY CLINIC INFECTIOUS DISEASE MPLS
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:
612-813-6777
Provider Business Practice Location Address Fax Number:
612-813-5820
Provider Enumeration Date:
02/28/2006