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Certified Provider Details:
| PROVIDER NUMBER: | 490095 |
| AGENCY NAME: | Center for Health Ethics and Law |
| CONTACT NAME: | Cindy Jamison |
| ADDRESS: | PO Box 9022 |
| CITY: | Morgantown |
| STATE: | WV |
| ZIP: | 26506 |
| PHONE: | |
| WEB SITE: | www.wvendoflife.org |
| EMAIL ADDRESS: | cjamison@hsc.wvu.edu |
| BSW/MSW NAME: | James Keresztury |
| DUE TO RECERTIFY DATE: | 7/1/2012 |
| COMMENTS: |