| NPI | 1427135045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MARK PIETSCH Owner 651-702-7800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 3581) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |