| NPI | 1750524187 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN RAY GIFFORD Executive Director 952-412-0486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN DC3889) |
| Enumeration Date | 2009-04-15 |
| Last Update Date | 2009-04-15 |