NPI | 1225101405 |
---|---|
Entity Type | Organization |
Authorized Contact | FRANCES GREEN Hr 651-290-2111 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MN 3432431) |
Enumeration Date | 2006-11-16 |
Last Update Date | 2020-01-10 |