| NPI | 1992060016 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOY KIMBALL Contract Manager 763-349-6740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QE0002X Clinic/Center Emergency Care |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2024-05-07 |