| NPI | 1710540968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE ELAINE RIESMEYER Credentialing Coordinator 304-243-3124 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-04-15 |