| NPI | 1912104928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER KARL PONS President 304-624-6122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 14659) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WV 14659) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2020-08-22 |