| NPI | 1740653575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI LYN WEISE Owner 612-280-3048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 15625) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-02 |