| NPI | 1376203125 |
|---|---|
| Doing Business As | PROVO DIALYSIS |
| Entity Type | Organization |
| Authorized Contact | JOHN WINSTEL Chief Accounting Officer 253-733-4501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2021-12-21 |