| NPI | 1033552971 |
|---|---|
| Doing Business As | FAIRVIEW NORTH BRANCH CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2023-04-12 |