| NPI | 1114343423 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN SHANNON Operations Manager 701-757-2812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2019-07-10 |