| NPI | 1255403002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOMINADOR YTI LAO Physician 304-732-9045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: WV 12700) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2019-01-07 |