Organization
PREMIUM MARTIAL ARTS WV LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA LYNN MADDEN (OWNER/INSTRUCTOR)
(304) 807-0251
Entity
Organization
Contact information
Practice address
963 DUNBAR VILLAGE PLZ, DUNBAR, WV 25064-3137
(304) 807-0251
Mailing address
602 CROSSROADS VLG, NITRO, WV 25143-2054
(304) 807-0251
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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