| NPI | 1841725454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY E LAGOS Operations Manager 304-574-9876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WV 2313-9790) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |