| NPI | 1619579208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY HACKNEY Owner 304-623-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2021-11-05 |