| NPI | 1518168053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARITA L BENNETT Owner 304-799-0011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 1755) |
| Additional Taxonomies | 251B00000X Case Management (Licence: WV 1755) |
| 207Q00000X Family Medicine (Licence: WV 1755) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2012-03-06 |