| NPI | 1205387719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA M NEWSOME Dministrator 304-940-1395 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 20A10710) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |