| NPI | 1710080189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD PAUL QUARANTILLO President 304-258-8805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 17667) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 17621) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-08-22 |