| NPI | 1508302027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE MANDIEKA Program Director 952-479-0172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center, Student Health |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2017-01-08 |
| Last Update Date | 2020-05-10 |