| NPI | 1255397170 |
|---|---|
| Doing Business As | FORT WALTON BEACH DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | THOMAS O. USILTON Group Vice President 770-541-7922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-12 |