| NPI | 1902386089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA SCHOTT CEO 320-200-7574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-08-17 |
| Last Update Date | 2018-08-17 |