| NPI | 1942612197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA M RUMBLE Provider Enrollment 304-285-7101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology |
| 261QS1000X Clinic/Center, Student Health | |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2014-05-22 |