| NPI | 1770912271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KURT A WICAL Director 651-340-4597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MN 1357) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2013-11-05 |