| NPI | 1164255733 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRINCESS GEHYIGON WALLACE Owner 763-913-8125 |
| Organization Subpart ? | No |
| Primary Taxonomy | 252Y00000X Early Intervention Provider Agency |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2024-08-20 |
| Last Update Date | 2025-06-23 |