| NPI | 1306208731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY BERNARD MAXWELL CFO/Co Owner 304-254-4622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: VA 0104556437) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-12-30 |