| NPI | 1982376208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY PELLETIER VP Of Business Services 763-767-7124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-10-05 |