| NPI | 1053840157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON PETTRESS Center Manager 304-905-6421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2017-06-12 |