| NPI | 1871879676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MYIA M XIONG Pharmacist 651-487-3319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: MN 260525) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: MN 302R00000X) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |