| NPI | 1750876124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIN RENZ-JOHNSON Billing Manager 701-271-1494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2024-04-03 |