| NPI | 1902953474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM B. DAVIS President 952-261-9935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MN 904066000) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2008-06-24 |