| NPI | 1639402571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY KORST Billing Represatative 763-244-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN LMFT1986) |
| Additional Taxonomies | 251S00000X (Licence: MN LPCCcc00085) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2016-11-09 |