Provider First Line Business Practice Location Address:
BERRY PSYCHOLOGICAL SERVICES
Provider Second Line Business Practice Location Address:
3340 REPUBLIC AVENUE, SUITE 120
Provider Business Practice Location Address City Name:
ST. LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-4154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-916-5605
Provider Business Practice Location Address Fax Number:
612-813-8263
Provider Enumeration Date:
09/13/2005