| NPI | 1235430216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY ELIJAH JOHNSON President 701-640-8773 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: ND 607) |
| Enumeration Date | 2010-11-08 |
| Last Update Date | 2011-01-11 |