| NPI | 1962988782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSAIRE P DAIGLE Owner 651-503-0695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: MN LP6226) |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2021-01-09 |