Provider First Line Business Practice Location Address:
401 PHALEN BLVD - MS 11503G
Provider Second Line Business Practice Location Address:
HEALTHPARTNERS SPECIALTY CENTER 401
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55130-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-254-3490
Provider Business Practice Location Address Fax Number:
651-254-7033
Provider Enumeration Date:
12/20/2005