| NPI | 1255340758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL W. CRAIG Owner 304-522-7268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WV 18116) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-22 |