| NPI | 1376166496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALFONSO MORALES-UTRILLA Medical Director 612-730-5196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2020-05-22 |