| NPI | 1215695168 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEANN REESE Owner CEO 320-634-6434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |