| NPI | 1639767791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAWN GROSLIE Owner 701-941-0175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2024-03-29 |