| NPI | 1124456421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY HILLMAN Front Desk Manager 218-829-8863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MN 9105) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2013-10-23 |