Provider First Line Business Practice Location Address:
4201 MINNEHAHA AVE SO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
54406-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-721-2833
Provider Business Practice Location Address Fax Number:
612-721-4356
Provider Enumeration Date:
11/29/2006