Provider First Line Business Practice Location Address:
4050 COON RAPIDS BLVD
Provider Second Line Business Practice Location Address:
UNIT 4 WEST, PEDIATRIC HOSPITALIST
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-236-9765
Provider Business Practice Location Address Fax Number:
763-236-7422
Provider Enumeration Date:
03/24/2006