| NPI | 1508102500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA HALEY Operations Manager 952-456-6160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: MN 24538) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2013-09-10 |