| NPI | 1104386572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES LEWIS LAYTART Credentialing Specialist 952-915-6248 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0700X Clinic/Center Hearing and Speech |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2019-05-29 |