| NPI | 1265806954 |
|---|---|
| Other Name | RENAE COOLEY |
| Entity Type | Organization |
| Authorized Contact | RENAE ANN COOLEY Owner/Qp/Aa 651-383-6764 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |