| NPI | 1811014806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY PETER BAMBENEK Medical Director 218-727-4531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-08-22 |