| NPI | 1619319282 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SELISA SHARON BHAVSAR Clinic Manager 304-252-9890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WV 11044) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2013-07-24 |