Provider First Line Business Practice Location Address:
800 EAST 28TH STREET
Provider Second Line Business Practice Location Address:
INTERNAL MAIL ROUTE 11326
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407-3799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-863-1893
Provider Business Practice Location Address Fax Number:
612-863-3809
Provider Enumeration Date:
01/24/2006