| NPI | 1891001277 |
|---|---|
| Doing Business As | PROVIDENCE PEDIATRIC NORTH |
| Entity Type | Organization |
| Authorized Contact | KEVIN WALSTROM CFO 509-482-2367 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2010-08-24 |