| NPI | 1194906495 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KOLADE COKER Program Administrator 763-862-0169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MN 335537) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-15 |