| NPI | 1669653796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA G LONG Office Manager 304-675-6060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WV 13842) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2008-06-27 |