| NPI | 1659586428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY S DEGUZMAN Owner 304-234-1817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WV 19734) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-08-22 |