| NPI | 1467959502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE MANDIEKA Administrator 952-479-0814 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center Urgent Care |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| 261QP2300X Clinic/Center Primary Care | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2023-09-25 |