| NPI | 1578781639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSIE PETERSON COO 218-722-1497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2021-02-08 |