| NPI | 1972744522 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY POLING Member 304-255-2527 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WV 1002-2421) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2009-03-11 |