| NPI | 1730347402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN WITCHEY Director 304-262-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WV UD000018511001) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2008-05-29 |