| NPI | 1174579551 |
|---|---|
| Doing Business As | LAKE AVENUE DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | JAMES K HILGER Chief Accounting Officer 253-272-1916 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2012-07-03 |