Provider First Line Business Practice Location Address:
540 CEDAR ST
Provider Second Line Business Practice Location Address:
MN DEPT HUMAN SERVICES 64984
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55101-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-431-3431
Provider Business Practice Location Address Fax Number:
651-431-7420
Provider Enumeration Date:
09/15/2006