| NPI | 1417188830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY R BOLLER Administrator 320-252-0233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: pending) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2009-08-03 |