| NPI | 1104356419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRAMY ICENHOWER Administrator 870-584-0272 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2022-07-21 |