| NPI | 1417249459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUDOLPH MICHAEL KEVAK Owner 304-201-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: WV 18688) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2011-05-10 |