| NPI | 1891392734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LANDERS Director Of Credentialing 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-10-05 |
| Last Update Date | 2020-10-05 |