| NPI | 1972830891 |
|---|---|
| Doing Business As | PARK-LAKE CLINIC |
| Entity Type | Organization |
| Authorized Contact | JOHN R. LUNDSTROM Owner/President 651-235-1403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: MN 2261) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2009-11-13 |