| NPI | 1588302707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMISTYENE BRINCEFIELD Operations Manager 763-464-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2022-05-26 |
| Last Update Date | 2022-08-29 |