Provider First Line Business Practice Location Address:
1930 COON RAPIDS BLVD NW
Provider Second Line Business Practice Location Address:
FAMILY LIFE MENTAL HEALTH
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433-4708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-427-7964
Provider Business Practice Location Address Fax Number:
763-427-7926
Provider Enumeration Date:
10/24/2012