| NPI | 1619163904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MARTIN WITTE President/Owner 651-739-1905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN 1584) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2007-09-20 |