| NPI | 1790159879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CZESLAW J HORDYNSKI Business Manger 612-237-9238 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN LP3966) |
| Enumeration Date | 2015-11-30 |
| Last Update Date | 2015-11-30 |