NPI | 1063731107 |
---|---|
Entity Type | Organization |
Authorized Contact | JEANNIE LATICIA STEWART CEO/President 304-345-2014 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WV 99FMG) |
Enumeration Date | 2010-05-28 |
Last Update Date | 2010-05-28 |