| NPI | 1609136019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN CHEN Owner 618-922-9952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-05-18 |