| NPI | 1881086288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN SUE JOHNSON Owner 651-492-4938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 2085) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2015-02-23 |