| NPI | 1659740066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIFFORD WILLIAM ROBERSON Owner 304-812-4182 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WV 22760) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WV 22760) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2016-03-18 |