| NPI | 1558870394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JARROD VARNER Owner 612-423-3678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: FL CH12219) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |