| NPI | 1619343951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN JASON WOLEN Owner 304-233-2455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 22703) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: WV 22703) |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2024-04-05 |