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Goodwill (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2015
Dec. 31, 2014
Dec. 31, 2013
Goodwill [Roll Forward]      
Beginning balance $ 147,914 $ 143,955  
Goodwill acquired during the year 23,428 12,974  
Goodwill allocated to specific assets for businesses acquired in 2013 0 (9,760)  
Goodwill adjustments for purchase price allocation of businesses acquired 385 880  
Goodwill written-off - closed clinics (180) (135) $ 0
Ending balance $ 171,547 $ 147,914 $ 143,955