Provider First Line Business Practice Location Address:
2450 RIVERSIDE AVENUE
Provider Second Line Business Practice Location Address:
UNIVERSITY OF MINNESOTA AMPLATZ CHILDREN'S HOSPITAL, FA
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-273-6055
Provider Business Practice Location Address Fax Number:
612-273-4340
Provider Enumeration Date:
01/25/2010