| NPI | 1124685532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAY KELLER Managing Individual 651-324-0266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2019-06-20 |