| NPI | 1902580780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SPRADLING Fnp/ Medical Director 304-962-1008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QG0250X |
| Enumeration Date | 2023-06-13 |
| Last Update Date | 2024-02-16 |