| NPI | 1285990002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA ANN PETERSON Partner 952-808-6848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 20365) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MN 20366) |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2013-11-13 |