Provider First Line Business Practice Location Address:
1304 UNIVERSITY AVE NE
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:
55413-4599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-308-9973
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2025