| NPI | 1114062031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL WATSON PETERSON President 304-757-6736 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 14044) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2011-10-07 |