| NPI | 1053704635 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTINE MORALES Clinic Director 651-644-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MN 1123204) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2015-03-06 |