| NPI | 1184708117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LYNN JOHNSON Administrator 651-739-2225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 3627687) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2017-02-09 |