| NPI | 1164975645 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE MORGAN GARRETT Chief Manager 651-325-8656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 1662) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2016-08-01 |