| NPI | 1760651038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD RAY TOLLEFSON Owner 763-754-2573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MN 2478) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2008-02-21 |