Provider First Line Business Practice Location Address:
3221 E 24TH ST
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:
55406-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-722-0867
Provider Business Practice Location Address Fax Number:
612-672-4113
Provider Enumeration Date:
01/18/2007