| NPI | 1992267462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LANDERS Executive Assistant 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2021-05-14 |