| NPI | 1922407972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARIE GRACE Co Owner 612-578-2167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MN 2916) |
| Additional Taxonomies | 251S00000X (Licence: MN cc00826) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |