| NPI | 1194140749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH GRAVELLE THOENY Owner 612-239-6017 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 2150) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2014-02-19 |