| NPI | 1457657249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINICO TALLARICO COO 612-222-2222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2025-01-23 |