| NPI | 1780992719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS ALLEN SULT Medical Director/Owner 320-347-1212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 37054) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2015-03-23 |