Provider First Line Business Practice Location Address:
8170 33RD AVE S
Provider Second Line Business Practice Location Address:
C/O PHYSICIAN SERVICES MS 21110Q - HEALTHPARTNERS FLOAT
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55440-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-429-7775
Provider Business Practice Location Address Fax Number:
651-429-7774
Provider Enumeration Date:
03/09/2006