Provider First Line Business Practice Location Address:
2908 HUMBOLDT AVE S
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:
55408-1953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-875-1121
Provider Business Practice Location Address Fax Number:
612-822-2766
Provider Enumeration Date:
02/15/2011