| NPI | 1710129812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI M JOSEPH Clinic Administrator 651-256-6706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MN 154) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2016-12-07 |