| NPI | 1205397395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN MOORE CEO 651-602-7537 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2024-05-15 |