| NPI | 1710079595 |
|---|---|
| Doing Business As | 31ST STREET MEDICAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | RICHARD LAYNE DEL CHECCOLO Physician 304-525-9100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-03-12 |