| NPI | 1669496345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT KETOVER President 612-871-1145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN Pending) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2024-04-02 |