| NPI | 1760922413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETTINA TAYENGCO LIMJOCO Medical Director 304-840-8406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CA C51899) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |