| NPI | 1083093835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN LUNDEEN Owner 701-361-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MD U02129) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |