| NPI | 1467439463 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BECKY S FONDALE Office Manager 304-256-0242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WV 17491) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV 18402) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2011-05-13 |