| NPI | 1245624246 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KIRK DODSON Director 651-315-2192 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: MN 52435) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2015-03-27 |