Individual
MR. JOHNNIE LEGRANT LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4347 4TH AVE S, MINNEAPOLIS, MN 55409-2115
(612) 823-3880
Mailing address
4347 4TH AVE S, MINNEAPOLIS, MN 55409-2115
(612) 823-3880
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
270227392
MN
Other
Enumeration date
08/26/2012
Last updated
08/26/2012
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