| NPI | 1285174805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRIS R SMITH Program Director 612-977-3952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251X00000X Supports Brokerage (Licence: MN M697635201) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2017-03-01 |