| NPI | 1235169384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE N. PETERSEN Co Owner 304-465-0544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 1864) |
| 207R00000X Internal Medicine (Licence: WV 941) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-08-22 |