Provider First Line Business Practice Location Address:
3007 HARBOR LANE NORTH
Provider Second Line Business Practice Location Address:
PARK NICOLLET CLINIC PLYMOUTH - FAMILY MEDICINE
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-8900
Provider Business Practice Location Address Fax Number:
952-993-8955
Provider Enumeration Date:
10/05/2012