| NPI | 1457863185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER TURNER Manager 701-355-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ND 14678) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: ND 14678) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2023-12-12 |