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Property and Equipment (Tables)
 12 Months Ended
Dec. 31, 2018
Property, Plant and Equipment [Abstract]  
Property and Equipment Property and equipment were comprised of the following:
 
December 31,
 
2018
 
2017
Land
$
37,384

 
$
33,814

Buildings
467,181

 
473,489

Leasehold improvements
3,164,943

 
2,816,675

Equipment and information systems, including internally developed software
2,586,564

 
2,352,246

New center and capital asset projects in progress
661,695

 
576,651

 
6,917,767

 
6,252,875

Less accumulated depreciation
(3,524,098
)
 
(3,103,662
)
 
$
3,393,669

 
$
3,149,213