| NPI | 1477852317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDY RAE JUNG Program Director 612-414-7997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1460478) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2011-03-17 |