| NPI | 1316369911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA KAY WIITA Sole Shareholder 952-777-2355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 42376) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |