| NPI | 1639340409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK STANLEY MELLSTROM President 952-469-3393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 27926) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2008-04-23 |