Organization
PHOENIX
Active
Other names
Phoenix
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY JAMES KORTUS (CO-FOUNDER)
(651) 795-8759
Entity
Organization
Contact information
Practice address
6697 ELM ST, NORTH BRANCH, MN 55056-7045
(651) 795-8759
Mailing address
6697 ELM ST, NORTH BRANCH, MN 55056-7045
(651) 795-8759
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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