| NPI | 1982877064 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOLONGO PUREV Dmd 952-929-2388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MN d11735) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2008-04-09 |