| NPI | 1235408121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA LYNN ROBERTSON Benefits Coordinator 304-792-7130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WV 11) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2020-01-30 |