| NPI | 1285979047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI B GILDERSLEEVE Owner 612-386-3365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP3779) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |