| NPI | 1184736126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE JORGE GORDINHO Owner/President 304-254-9022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-06-24 |