| NPI | 1871580969 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL RANDOLPH SHELTON Owner 304-809-5312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2018-09-27 |