| NPI | 1578556577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY WOOTEN Credentialing Coordinator 304-736-4744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2009-07-15 |