Provider First Line Business Practice Location Address:
2199 HIGHWAY 36 E
Provider Second Line Business Practice Location Address:
TARGET CLINIC
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55109-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-779-5986
Provider Business Practice Location Address Fax Number:
651-773-4170
Provider Enumeration Date:
02/02/2006