| NPI | 1962879775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA L MOUL Credentialist/Corporation Secretary 304-743-8281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: KY 5391) |
| Enumeration Date | 2015-08-27 |
| Last Update Date | 2015-08-27 |