| NPI | 1396063459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLONG BLIAXA VANG Owner 651-210-9657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MN 4471) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2010-05-12 |