| NPI | 1104150044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY RUSSELL MAJCHRZAK Owner 218-729-9831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 1031815-4-AFC) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2009-09-24 |