| NPI | 1861884579 |
|---|---|
| Doing Business As | WAYSIDE WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | JESSIE C EVERTS Director Of Clinical Services 952-405-7632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 1056564-2-CDT) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2015-03-04 |