| NPI | 1700948239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE M BROWN Office Manager 304-637-0433 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV WV1965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV WV1833) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |