| NPI | 1992230411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLISS LATASHA MCMORRIS Founder/CEO 612-986-9756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TN 305R00000X) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |