| NPI | 1578960019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIRSI ABDULKADIR MOHAMED Vice President 605-215-4959 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: SD DL040826) |
| Enumeration Date | 2014-11-27 |
| Last Update Date | 2014-11-27 |