| NPI | 1366758021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOREAN DALISE YOCCO Office Manager 304-842-6609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WV 237) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2010-08-19 |