NPI | 1811405616 |
---|---|
Entity Type | Organization |
Authorized Contact | SHAWN ROBERT BLANKENSHIP Owner 304-553-1576 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
Enumeration Date | 2018-01-15 |
Last Update Date | 2023-08-22 |