| NPI | 1437118619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN MOORE CEO 651-602-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MN 302133) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-05-15 |