| NPI | 1659437044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY E YOUNGREN Medical Credentialing Coordinator 651-696-5640 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2020-08-22 |