| NPI | 1336740364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFONSO MORALES-UTRILLA Owner 651-644-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |