| NPI | 1104095041 |
|---|---|
| Doing Business As | SOUTH BROAD STREET DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | JOHN D WINSTEL Chief Accounting Officer 253-733-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2020-06-17 |