| NPI | 1215152863 |
|---|---|
| Doing Business As | FAIRVIEW RIVERSIDE CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MN 2625373) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2023-04-12 |