| NPI | 1639980808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BUKOLA O KUTI Owner 651-230-1900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |