| NPI | 1396508586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON HENNESSEY VP, Credentialing And Enrollment 304-282-4929 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2025-11-17 |