| NPI | 1184851115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA BETH CAROS Executive Director 612-872-8086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2009-06-17 |