| NPI | 1568817492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN MJ MARSH Owner 612-702-9850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 1091) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2016-04-28 |