| NPI | 1023362027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY WILLIAM EDWARD VEECK Billing Manager 612-902-5916 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: MN 1063313) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-11-01 |