| NPI | 1750541371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED NEWBERRY President Of Operations 612-462-0602 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX 25494) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2008-10-02 |