Provider First Line Business Practice Location Address:
8414 FILLMORE ST NE
Provider Second Line Business Practice Location Address:
NORTHEY DENTAL INC
Provider Business Practice Location Address City Name:
SPRING LAKE PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55432-1266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-496-0284
Provider Business Practice Location Address Fax Number:
763-496-0282
Provider Enumeration Date:
04/24/2006