| NPI | 1124350996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRY W. CONNER Director 651-495-9494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1053675-1-CDT) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2010-02-04 |