| NPI | 1023394673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY M CHANDLER Chief Manager 218-301-9122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN R-137452-6) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2011-10-27 |