| NPI | 1184879660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA ANN SHARPS Owner 304-368-9393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WV 726D) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: WV 727D) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2009-04-17 |