| NPI | 1467667030 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY D MILLER Provider Relations Analyst 304-293-5033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 0011526000) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |