| NPI | 1831379338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL MERRITT KOSTENKO President 304-763-0199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WV 1078) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2007-11-13 |