Provider First Line Business Practice Location Address:
227 COLFAX AVENUE NORTH, SUITE 130
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:
55405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-803-6644
Provider Business Practice Location Address Fax Number:
612-817-3613
Provider Enumeration Date:
04/21/2010