| NPI | 1578121356 |
|---|---|
| Doing Business As | FAIRVIEW GRAND ITASCA CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | ROBERT BEACHER President 612-672-5139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2022-08-31 |