| NPI | 1629175617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN L. OLSON Director 952-746-1018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN HFID24276) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-06-14 |