Provider First Line Business Practice Location Address:
345 N. SMITH AVE, MAIL STOP 70-503
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITALS AND CLINICS OF MINNESOTA
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-220-6479
Provider Business Practice Location Address Fax Number:
651-220-6393
Provider Enumeration Date:
09/21/2011