| NPI | 1295385599 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN CORDIAL Credentialing Coordinator 606-886-8572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2020-06-17 |