| NPI | 1770780876 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE K RAVERTY Clinic Administrator 651-224-8264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QX0100X Clinic/Center, Occupational Medicine (Licence: MN 30816) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: MN 42667) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2010-10-20 |