| NPI | 1669534608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RUSSELL HEAGLE President Owner 952-934-3296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2020-08-22 |