| NPI | 1982145157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM MOSSALLATI Owner 304-203-5754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-11-21 |