| NPI | 1306992425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIANA GRACE RAYMOND Manager Provider Enrollment 734-343-1466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2026-05-04 |