| NPI | 1154712032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER GROSE CEO 304-250-6047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV 77359) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |