| NPI | 1801266499 |
|---|---|
| Doing Business As | LT PROACTIVE CARE CLINIC |
| Entity Type | Organization |
| Authorized Contact | KAMBIZ FARBAKHSH Owner/Medical Director 952-541-7157 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2015-09-25 |