| NPI | 1972553741 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER D HOLMBERG President 763-786-9543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MN HFID#04305) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2016-08-03 |