NPI | 1255505079 |
---|---|
Entity Type | Organization |
Authorized Contact | ESTELLA KARIN GARDER Owner 763-439-8119 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MN 672968000) |
Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: MN 672968000) |
302R00000X Health Maintenance Organization (Licence: MN 672968000) | |
Enumeration Date | 2008-04-14 |
Last Update Date | 2008-04-14 |