| NPI | 1093471484 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT ALLEN LAWRENCE Clinical Director 218-779-7005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2021-11-10 |