| NPI | 1710097274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI LEE HACKMANN CEO/Clinical Director 952-562-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: MN 7076053 00) |
| Additional Taxonomies | 261QM0801X (Licence: MN 7876190 00) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-07-21 |