Organization
RIVERSIDE HEALTH CENTER LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER RUSSELL (ADMINISTRATIVE ASSISTANT)
(304) 734-2040
Entity
Organization
Contact information
Practice address
1 WARRIOR WAY STE 103, BELLE, WV 25015-1356
(304) 734-2040
(304) 734-2047
Mailing address
PO BOX 70, DAWES, WV 25054-0070
(304) 734-2040
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/26/2014
Last updated
09/26/2014
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