| NPI | 1396046504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON LANHAM Administrator 304-457-1670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WV 21095) |
| Additional Taxonomies | 251S00000X (Licence: WV 0139472) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |