| NPI | 1447583778 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS HANEL Owner 218-745-4601 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN d12024) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2009-09-18 |