| NPI | 1821185166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L BAMGBOSE Billing Supervisor 6106-301-5151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2007-09-04 |