| NPI | 1215236393 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN WINCKLER Sole Owner/Member 651-308-2366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: OR 4065) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2011-03-15 |