| NPI | 1245516178 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRK EDWARD HANSON CEO 612-720-3824 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Additional Taxonomies | 335G00000X Medical Foods Supplier |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2011-10-24 |