| NPI | 1831200120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN MACIK Administrator 320-214-5759 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN 330845) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-06-11 |