| NPI | 1871052324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER CAO Office Manager 612-202-8502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-03-14 |