| NPI | 1184720864 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANEL M BROUSSEAU Administrator/Bookkeeper 701-475-2582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center, Public Health, State or Local |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2020-08-22 |