| NPI | 1598165052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE GATTON Counselor 218-839-9421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN 451) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: MN 24) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2014-09-02 |