| NPI | 1831827476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA M LAWSON Credentialing 218-631-5238 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-08-11 |