| NPI | 1376579607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S RUSSO Owner 239-513-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2010-10-25 |