Provider First Line Business Practice Location Address:
2800 UNIVERSITY AVE SE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-638-2282
Provider Business Practice Location Address Fax Number:
612-326-7642
Provider Enumeration Date:
03/15/2007