| NPI | 1942602081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY THAO Owner 763-587-8920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 383938451) |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2014-09-20 |