| NPI | 1114132867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA HAWTHORNE Practice Administrator 304-225-2236 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 21247) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2019-11-06 |