| NPI | 1902014038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY MILLER Provider Relations Analyst 304-293-5033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 67050360001) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-08-22 |