| NPI | 1982648267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMICA JOHNSON Credentialing / Billing Specialist 870-773-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2020-03-13 |