| NPI | 1528879277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE A WELLS Sr Director Of Provider Services 304-597-3525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 213E00000X Podiatrist | |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-01-14 |