| NPI | 1184867319 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY CHARLES FORS Clinic Director 763-862-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN 1836) |
| Enumeration Date | 2009-04-17 |
| Last Update Date | 2015-05-01 |