| NPI | 1598430084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYA C LYDEEN SVP/Practice Administrator 952-832-5252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2021-08-16 |