| NPI | 1992175889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA KENNEDA Credentials Coordinator 304-255-2121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA (Licence: WV RP0007053) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2015-10-05 |