| NPI | 1568503845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA G. NORBY Executive Assistant/Credentialing 763-398-2203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN Pending) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2012-12-17 |