| NPI | 1023691599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR A ORLOV Director Of Credentialing 606-638-0938 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2021-05-03 |