| NPI | 1548696644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVINA R AGEE Owner 304-940-0085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WV AP00943540) |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2013-09-20 |