| NPI | 1356988554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH LYNN SODERHOLM Business Office Manager 218-481-7812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2019-12-06 |
| Last Update Date | 2019-12-06 |