| NPI | 1912374943 |
|---|---|
| Doing Business As | JSA MEDICAL GROUP- WEST COLONIAL |
| Doing Business As | DAVITA MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | JOHN G. LIETHEN Secretary 952-205-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: FL ME74038) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2019-08-20 |