11MN
Organization (NPI-2)
Active
Community/Behavioral Health
Provider Information
- NPI Number
1154601474- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 720 3RD AVE NE STE 109, MINNEAPOLIS, MN, 554132300
- Phone
- (360) 237-2616
- Fax
- (360) 237-2616
Specialties & Taxonomies
Community/Behavioral Health
Primary License: MN #302775