| NPI | 1376117663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M KORTUS CEO 651-428-2797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2021-05-19 |