| NPI | 1366844078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIHAN A ALI Clinical Director 651-307-3987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 21047) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2014-09-24 |