Provider First Line Business Practice Location Address:
2736 LYNDALE AVE S.
Provider Second Line Business Practice Location Address:
#212
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55408-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-870-1570
Provider Business Practice Location Address Fax Number:
612-870-1571
Provider Enumeration Date:
07/27/2007