| NPI | 1649463936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZAMZAM A GESAADE Director 612-226-6383 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 276690100) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2007-08-21 |