| NPI | 1700196615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMAS E. VIGO PAREDES Owner 304-756-3143 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: WV 17682) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2011-04-01 |