| NPI | 1437313434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW J SWANSON Paralegal 612-922-7573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MN 37899) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MN 37899) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2008-07-18 |