| NPI | 1891886636 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA LYNN FR Manager 304-345-8500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 17129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 17020) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-08-22 |