Provider First Line Business Practice Location Address:
715 EDGERTON STREET
Provider Second Line Business Practice Location Address:
MERRICK COMMUNITY SERVICES
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-360-1966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2014