| NPI | 1861818742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIE WINSTON Owner 651-587-6423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN cc00654) |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |