| NPI | 1487949897 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK BOSTROM Executive Medical Director 218-546-7333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MN 38115) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2011-10-04 |