| NPI | 1225333164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RENEE ROUSSEAU Owner/Doctor 605-771-2700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TN 2364) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2011-01-25 |