| NPI | 1962685834 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: NM PENDING) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2020-02-12 |