| NPI | 1306330345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT GOODWIN Owner 304-319-1825 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WV UD000764150001) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-06-21 |