| NPI | 1083187579 |
|---|---|
| Other Name | --NONE-- |
| Entity Type | Organization |
| Authorized Contact | SEAL SOPHIE DWYER Principle 320-296-2530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2023-12-06 |