| NPI | 1245673482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY R JOHNSON Owner 320-905-0795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1071) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2013-09-03 |