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Organization

PROVO KIDNEY CARE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PAMELA VP (VICE PRESIDENT)
(480) 639-7186
Entity
Organization

Contact information

Practice address
920 WINTER ST, WALTHAM, MA 02451-1521
(480) 639-7186
(602) 798-8267
Mailing address
920 WINTER ST, WALTHAM, MA 02451-1521
(480) 639-7186
(602) 798-8267

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
001
UT

Other

Enumeration date
07/27/2016
Last updated
07/27/2016
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