| NPI | 1669971735 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANUEL R MORAN President 320-249-9588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN 34332) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2018-02-05 |