| NPI | 1023293503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOREEN MARIE LOOMIS Owner 320-632-2598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 9021) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2008-01-03 |