| NPI | 1174913339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL ROEHLKE Office Manager 320-774-2557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: MN D12960) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2020-09-09 |