| NPI | 1992995286 |
|---|---|
| Doing Business As | FAIRVIEW WYOMING CLINIC MTM |
| Entity Type | Organization |
| Authorized Contact | DAVID FASCHING CFO 612-617-3799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MN 2625360) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2023-04-13 |