| NPI | 1053495820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE BLAKE LILLY President 304-523-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WV WV17041) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |