| NPI | 1346832953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFONSO MORALES Owner 651-476-4412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2021-02-04 |