| NPI | 1255844130 |
|---|---|
| Doing Business As | FAYETTEVILLE ROAD 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 | 2017-11-14 |
| Last Update Date | 2023-06-20 |