| NPI | 1497528863 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILY CORREA Owner 651-332-9494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |