| NPI | 1215090501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA J BARGER Assistant Administrator 612-277-2165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MN 23) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2011-04-04 |