| NPI | 1962178269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA E MCCARTY Owner/Administrator 304-615-9925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-30 |