| 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 |