| NPI | 1821257593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERROL JAY NOLLER President 763-427-6897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: MN 23068) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |