| NPI | 1912355132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEVERLY SUE BROWN Administrater 612-978-2936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MN 17067782) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2016-05-27 |