| NPI | 1013207943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS MICHAEL SUSAG Owner 651-788-0538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN cc0182) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2011-04-12 |