| NPI | 1932316916 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI M JOSEPH Clinic Administrator 651-256-6706 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: MN 154) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2016-12-07 |