| NPI | 1437525292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI K HANSON CEO 651-210-6388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: MN 499997) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |