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Intangible Assets, net (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2018
USD ($)
Dec. 31, 2016
Operation
Dec. 31, 2017
USD ($)
Finite-Lived Intangible Assets, Net [Abstract]      
Total $ 48,828   $ 48,954
Number of acquired operations | Operation   2  
Tradenames [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Total 30,256   29,673
Referral Relationships [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Total 16,895   16,811
Accumulated amortization $ 9,370   7,209
Referral Relationships [Member] | Minimum [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Estimated useful life 6 years    
Referral Relationships [Member] | Maximum [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Estimated useful life 16 years    
Non-compete Agreements [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Total $ 1,677   2,470
Accumulated amortization $ 4,716   $ 4,100
Non-compete Agreements [Member] | Minimum [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Estimated useful life 5 years    
Non-compete Agreements [Member] | Maximum [Member]      
Finite-Lived Intangible Assets, Net [Abstract]      
Estimated useful life 6 years