Provider First Line Business Practice Location Address:
345 N SMITH AVE
Provider Second Line Business Practice Location Address:
SOCIAL WORK 70-503
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55102-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-220-6479
Provider Business Practice Location Address Fax Number:
651-220-6393
Provider Enumeration Date:
11/16/2011