| NPI | 1780897629 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOE CAREY ELLINGTON Member 304-425-3800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WV 10054254) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-12-08 |