| NPI | 1982346409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN MOORE CEO 651-602-7500 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2024-05-15 |