| NPI | 1174604409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LEIGH ENDICOTT Owner/Physician 304-768-4567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 2097) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2011-12-12 |