| NPI | 1841798543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY KIMBALL Contract Manager 763-349-6740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2018-01-28 |
| Last Update Date | 2024-05-07 |