| NPI | 1073603551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN R REXRODE Physician Director 304-358-7565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: WV 001) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-07-21 |