| NPI | 1376041822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE HALSNE Director Of Clinical Operations 952-698-9860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2018-01-30 |