is a Multi-specialty in , . practices all healthcare services and medical treatments related to Multi-specialty. The NPI Number for is 1679685150. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
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| Address | , , |
| Phone Number | |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1679685150 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | |
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| City | |
| State | () |
| Post Code | |
| Phone Number | |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Multi-specialty |
|---|---|
| Taxonomy | 193200000X |
| Licence No | 21188 |
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Definition: A business group of one or more individual practitioners, who practice with different areas of specialization. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3810000059 | WV | -- |
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