| NPI | 1669811295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY JON VAAGENES Owner 651-415-0446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MN 3144) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2013-06-25 |