| NPI | 1447021787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ASHWORTH Credentialing Specialist 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2024-01-15 |