| NPI | 1003123506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY KATE CANFIELD Owner 651-292-9247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 5414) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2011-01-21 |