| NPI | 1104006659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE S OLSON Owner 218-340-7884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 13106) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |