| NPI | 1730250234 |
|---|---|
| Doing Business As | MANTENO DIALYSIS CENTRE |
| Entity Type | Organization |
| Authorized Contact | STACEY A HARSY COO 815-937-8742 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center End-Stage Renal Disease (ESRD) Treatment (Licence: IL 000142671) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2013-05-23 |