| NPI | 1124508171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA LEIGH THOMPSON Administrative Assistant 304-897-5915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2018-08-20 |