Organization
SOUTHWEST RESIDENCE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAHAF DUNKAL (OWNER)
(952) 994-0998
Entity
Organization
Contact information
Practice address
9400 COLUMBUS AVE S, BLOOMINGTON, MN 55420-4528
(952) 994-0998
Mailing address
9400 COLUMBUS AVE S, BLOOMINGTON, MN 55420-4528
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/20/2024
Last updated
12/20/2024
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