| NPI | 1205940863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L. WENNER Executive Director 320-257-1777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN 1200898-2) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2009-10-19 |