| NPI | 1255733564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MOUNTAIN PITTMAN President 218-308-0294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: MN 29637) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-09-23 |