| NPI | 1578797916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN M FEARING Clinic Manager 952-473-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MN 22800) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2010-08-26 |