Provider First Line Business Practice Location Address: 
3400 UNIVERSITY AVE SE
    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: 
55414-3328
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
612-379-7232
    Provider Business Practice Location Address Fax Number: 
612-379-7233
    Provider Enumeration Date: 
11/17/2006