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