| NPI | 1407903248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELTA JORGENSEN Practice Administrator 763-592-8413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2019-01-04 |