| NPI | 1174416002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES VANG Medical Director 651-242-0220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QU0200X Clinic/Center Urgent Care |
| Enumeration Date | 2025-05-30 |
| Last Update Date | 2025-05-30 |