Provider First Line Business Practice Location Address:
ROBERTA J THEIS
Provider Second Line Business Practice Location Address:
8010 60TH AVE. NORTH
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-208-3784
Provider Business Practice Location Address Fax Number:
763-208-3784
Provider Enumeration Date:
01/22/2007