Provider First Line Business Practice Location Address:
HENNEPIN COUNTY GOVERNMENT CENTER A14
Provider Second Line Business Practice Location Address:
300 SO 6TH ST
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55487-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-348-0234
Provider Business Practice Location Address Fax Number:
612-677-6248
Provider Enumeration Date:
11/30/2011