| NPI | 1760721476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK JOSEPH PARKS Manager 651-334-6225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MN 35485) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2013-08-09 |