| NPI | 1477530459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLYN FAYE MUETZEL Administrative Manager 763-450-2001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-07-21 |