| NPI | 1174015796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA LEE JANSSEN Adminsitrator 815-744-5550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2019-06-03 |