| 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 |