| NPI | 1568786150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON L DYKES Medical Director 612-293-9977 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MN 40267) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 40267) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2010-03-25 |