| NPI | 1780500405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK MCDANIEL Owner/Member 304-610-6325 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2026-06-26 |
| Last Update Date | 2026-06-26 |