| NPI | 1497103386 |
|---|---|
| Doing Business As | SOUTHERN WV ENT |
| Entity Type | Organization |
| Authorized Contact | JUSTIN WAYNE DOUGLAS Owner/President 304-929-6930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WV 23770) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-22 |