Individual
BRENT CHAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
643 WHITE FAWN RD, MATHIAS, WV 26812-8665
(304) 636-9396
Mailing address
643 WHITE FAWN RD, MATHIAS, WV 26812-8665
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
02/22/2021
Last updated
06/29/2021
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