Provider First Line Business Practice Location Address:
3007 HARBOR LN N
Provider Second Line Business Practice Location Address:
PARK NICOLLET CLINIC PLYMOUTH
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-993-8900
Provider Business Practice Location Address Fax Number:
952-993-8955
Provider Enumeration Date:
12/14/2005