Individual
TEDLA A BELAYNEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
13626 GOSSAMER WAY, APPLE VALLEY, MN 55124-7875
(612) 999-0660
Mailing address
13626 GOSSAMER WAY, APPLE VALLEY, MN 55124-7875
(612) 999-0660
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
1099208
MN
Other
Enumeration date
11/22/2021
Last updated
11/22/2021
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