| NPI | 1427263664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY D MILLER Provider Relations Analsyt 304-293-5033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: WV 0007384008) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |