| NPI | 1134678410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER PAUL HANSON Owner 651-797-3756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MN 6001) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-12-15 |