| NPI | 1033299466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G. LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA A43374) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-08-19 |