| NPI | 1982828257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOBOLAJI SHIWONIKU Branch Coordinator 763-286-5224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN 333391) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |