Provider First Line Business Practice Location Address:
327 CENTRAL AVE SE
Provider Second Line Business Practice Location Address:
NORTH MEMORIAL - NORTHEAST FAMILY PHYSICIANS
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55414-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-379-1119
Provider Business Practice Location Address Fax Number:
612-379-4936
Provider Enumeration Date:
04/21/2009