| NPI | 1114585619 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER ELLIS Director/Family Nurse Practitioner 304-946-8350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-05-31 |