| NPI | 1568794675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONNE MOORE President 612-850-0016 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: MN R1138272) |
| Enumeration Date | 2010-02-01 |
| Last Update Date | 2010-02-01 |