Provider First Line Business Practice Location Address:
3300 OAKDALE AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-581-4159
Provider Business Practice Location Address Fax Number:
763-581-4150
Provider Enumeration Date:
03/24/2006