| NPI | 1477709392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RICHARD FOWLER President 952-545-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP1765) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2008-08-12 |