| NPI | 1144710658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY C GLASNER Md 701-364-4554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: ND 13699) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |