Most Relevant Information
Provider Data
| NPI Number: | 1003410028 |
| Provider Name: | MARTHA CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/30/2020 |
| Last Updated: | 11/30/2020 |
Provider Practice Location
382 BROADWAY AVE
MORGANTOWN
WV
265050364
Practice Location Phone/Fax
| Phone: | 3045997743 |
| Fax: |
Provider Mailing Location
382 BROADWAY AVE
MORGANTOWN
WV
265050364
Provider Mailing Phone/Fax
| Phone: | 3045997743 |
| Fax: |