| NPI | 1902219595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LESHER Vice President/Clinical Practice 651-636-4155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: MN 9299) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |