Provider First Line Business Practice Location Address:
2120 CLINTON 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:
55404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-871-0099
Provider Business Practice Location Address Fax Number:
612-871-0929
Provider Enumeration Date:
08/03/2010