Provider First Line Business Practice Location Address:
3005 JAMES AVE S
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:
55408-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-871-4250
Provider Business Practice Location Address Fax Number:
612-823-1820
Provider Enumeration Date:
01/24/2007