| NPI | 1164261517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOELLE DANIELLE MAHAGA KAMDEM Owner 304-208-2908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2024-08-09 |