| NPI | 1972837649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE LYNN COLLYARD-GLINSEK Owner 763-274-0377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MN DC 4090) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2015-01-07 |