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2404 1st St S Willmar MN 56201-6300 | |
| (320) 235-1235 | |
| (320) 235-9241 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 2404 1st St S, Willmar, Minnesota |
| Authorized Official Name and Position | Bradley L Backhaus (CEO) |
| Authorized Official Contact | 3202351235 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2404 1st St S Willmar MN 56201-6300 Ph: (320) 235-1235 | 2404 1st St S Willmar MN 56201-6300 Ph: (320) 235-1235 |
| NPI Number | 1760674782 |
|---|---|
| Provider Enumeration Date | 08/14/2007 |
| Last Update Date | 11/05/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760674782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2069 (Minnesota) | Primary |
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