Individual
BROOK PARENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3919 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2520
(763) 421-5559
(763) 421-9955
Mailing address
3919 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2520
(763) 421-5559
(763) 421-9955
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
BC400829
MN
Other
Enumeration date
04/28/2017
Last updated
04/28/2017
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