Provider First Line Business Practice Location Address:
2020 EAST 28TH STREET, SUITE 104
Provider Second Line Business Practice Location Address:
UNIVERSITY OF MINNESOTA MEDICAL CENTER, SMILEY'S CLINIC
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-333-0774
Provider Business Practice Location Address Fax Number:
612-359-0475
Provider Enumeration Date:
05/27/2016