| NPI | 1417438169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LARBI-ODAM Chief Executive Officer 952-228-0420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2023-07-06 |