Provider First Line Business Practice Location Address: 
200 1ST ST SW
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ROCHESTER
    Provider Business Practice Location Address State Name: 
MN
    Provider Business Practice Location Address Postal Code: 
55905-0001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
507-284-2511
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/25/2013