| NPI | 1548340813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAUL NORIEGA Dir. Of Hit And Billing 612-332-4973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: MN 6075748) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-02-07 |