| NPI | 1235211160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY T CORCORAN Owner 507-437-9085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP3552) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2008-06-16 |