| NPI | 1558783027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE WILSON Director 952-451-7003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN LP 5164) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-01-17 |