| NPI | 1073789269 |
|---|---|
| Doing Business As | SAME |
| Entity Type | Organization |
| Authorized Contact | KRISTI J MILLER Office Manager 218-751-3280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1015165-1-CDT) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2008-05-07 |