Provider First Line Business Practice Location Address:
640 JACKSON ST-MAIL STOP 11302C
Provider Second Line Business Practice Location Address:
HEALTHPARTNERS REGIONS BEHAVIORAL HEATLH-ST. PAUL
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55101-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-254-4786
Provider Business Practice Location Address Fax Number:
651-254-9426
Provider Enumeration Date:
10/21/2006