| NPI | 1619202934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY L EGELSTON Owner 952-470-6005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: MN R106374-5) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2009-10-05 |