Fairmont Ent Associates, Inc.
NPI #1659554046 in Kingwood, West Virginia
Provider Information
- NPI Number
- 1659554046
- Entity Type
- Organization
- Organization Name
- Fairmont Ent Associates, Inc.
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Dec 10, 2007
- Last Updated
- May 22, 2008
Practice Location
- Address
- 300 S PRICE ST
- City
- Kingwood
- State
- West Virginia
- ZIP Code
- 26537-1442
- Phone
- (304) 366-6157
Authorized Official
- Name
- DR. JOEDY L DARISTOTLE, M.D.
- Title
- PHYSICIAN
- Phone
- (304) 366-6157
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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