Provider First Line Business Practice Location Address:
2425 CHICAGO AVENUE SOUTH
Provider Second Line Business Practice Location Address:
CHILDRENS PRIMARY CLINIC - TAMS
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-813-6125
Provider Business Practice Location Address Fax Number:
612-872-2338
Provider Enumeration Date:
03/10/2006