| NPI | 1144429283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARA JEAN CUPERUS Owner 320-255-0961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 786) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2017-01-04 |