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10190 Baltimore St Ne Ste 100 Blaine MN 55449 | |
| (763) 780-8264 | |
| (763) 780-8274 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 10190 Baltimore St Ne Ste 100, Blaine, Minnesota |
| Authorized Official Name and Position | John Anderson (PRESIDENT) |
| Authorized Official Contact | 9723648000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5080 Spectrum Dr Ste 1200w Addison TX 75001-4624 Ph: () - | 10190 Baltimore St Ne Ste 100 Blaine MN 55449 Ph: (763) 780-8264 |
| NPI Number | 1548741994 |
|---|---|
| Provider Enumeration Date | 08/23/2018 |
| Last Update Date | 08/23/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548741994 | NPI | - | NPPES |
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