| NPI | 1306530043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YEE XIONG Owner 651-726-4779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 261Q00000X Clinic/Center | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2023-06-06 |