Organization
PHOENIX TREATMENT CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD KALOU MD (OWNER)
(304) 688-7027
Entity
Organization
Contact information
Practice address
4114 1ST AVE, NITRO, WV 25143-1304
(304) 755-0119
Mailing address
PO BOX 11908, CHARLESTON, WV 25339-1908
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
08/15/2021
Last updated
08/15/2021
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