Organization
CITY OF BRAINERD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS W JAY (COORDINATOR)
(218) 828-6172
Entity
Organization
Contact information
Practice address
501 LAUREL ST, BRAINERD, MN 56401-3595
(218) 828-6172
(218) 828-6172
Mailing address
501 LAUREL ST, BRAINERD, MN 56401-3595
Taxonomy
Speciality
Code
Description
License number
State
347B00000X
Bus
Primary
—
—
Other
Enumeration date
01/23/2013
Last updated
01/23/2013
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