| NPI | 1174776561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN ROGER WIESE Owner/Director 651-633-5290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2008-10-29 |