| NPI | 1841743283 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN LOKENSGARD Business Manager 651-338-5055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 8768) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |