| NPI | 1922148774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW R DEROSIER President 218-284-6040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MN 517) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2007-12-01 |