| NPI | 1093039786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI ANDERSON Owner 218-407-1008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1411076) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2013-06-03 |