Provider First Line Business Practice Location Address:
4432 CHICAGO AVE SO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-870-2463
Provider Business Practice Location Address Fax Number:
612-870-2428
Provider Enumeration Date:
03/13/2007