| NPI | 1144644717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL HANSON Medical Director 651-324-8693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN 679516700023) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2019-12-19 |