| NPI | 1134184229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSCAR P CARRILLO President/Physician 304-475-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WV 12882) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-08-22 |