| NPI | 1114268943 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHLEEN MARIE KELLY Owner 612-750-0263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 19327) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2013-03-04 |