| NPI | 1215975438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA JEAN SOLOMON Office Manager 304-782-2000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 15251) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: WV 51D0725830) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-03-05 |