| NPI | 1700166659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA RUMBLE Provider Enrollment Specialistq 304-293-5033 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2011-08-24 |