| NPI | 1659543296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN A PAYNE Credentialing Specialist 304-675-4340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: WV 6) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 1246) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2018-09-25 |