| NPI | 1295886208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN MOORE Executive Director 651-602-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-05-15 |