| NPI | 1598165664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES ROBERT SIMMONS Administrator 763-577-7240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2015-02-23 |