| NPI | 1861851545 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | AHMED ALI ABDIRAHMAN Owner 612-404-5058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2016-02-23 |