Provider First Line Business Practice Location Address:
516 DELAWARE ST SE
Provider Second Line Business Practice Location Address:
UNIV. OF MN PHYSICIANS PWB 1ST FLOOR, CLINIC 1A
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55455-0356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-626-3004
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2006