| NPI | 1740584119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G. LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: CA 640447) |
| Enumeration Date | 2010-12-29 |
| Last Update Date | 2019-08-19 |