| NPI | 1346628534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NIKOLIS GUSTAFSON Athletic Trainer 612-242-2676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MI 3667518) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |