NPI | 1659647014 |
---|---|
Entity Type | Organization |
Authorized Contact | DEREK DALTON Owner 304-310-4721 |
Organization Subpart ? | No |
Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: WV PT002703) |
Enumeration Date | 2012-03-29 |
Last Update Date | 2012-06-26 |