CRYSTAL BASTIN MD LLC

SOUTH CHARLESTON, WV
NPI1053539387
Entity TypeOrganization
Authorized ContactSHANNON G DAVIS
Office Manager
304-720-0390
Organization Subpart ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: WV  20368)
Enumeration Date2007-04-23
Last Update Date2013-11-12
Business Address
CRYSTAL BASTIN MD LLC
4820 KENTUCKY ST
SOUTH CHARLESTON, WV 25309-1310
Phone number: 304-720-0390
Mailing Address
CRYSTAL BASTIN MD LLC
4820 KENTUCKY STREET
SOUTH CHARLESTON, WV 25309-1364
Phone number: 304-720-0390
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