| NPI | 1144258849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDA MAE ODELL COWLES Admininstrator 952-345-2210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 604) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-08-17 |