| NPI | 1932519535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY B PHILLIPS Owner 952-835-6488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: MN 31205q) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2014-12-03 |