Individual
LESLIE B GOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
256 ALBA AVE, CHESTER, WV 26034-1559
(304) 479-5144
Mailing address
PO BOX 434, CHESTER, WV 26034-0434
(304) 479-5144
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/16/2020
Last updated
11/16/2020
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