| NPI | 1487891768 |
|---|---|
| Doing Business As | FAIRVIEW EDEN PRAIRIE CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MN 2625726) |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2023-03-16 |