| NPI | 1164889952 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LACY MICHELLE DAVIDSON Owner 304-633-0675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: WV 934) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-09-15 |