| NPI | 1962769687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY J. HAYCRAFT-WILLIAMS Owner 612-706-9630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 39788) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2012-04-19 |