| NPI | 1699970335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE M YOUNG President 304-525-6132 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 16077) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: WV 16077) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WV 16077) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2008-05-19 |