| NPI | 1063048189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA L POTASNIK Credentialing COO Rdinator 304-561-5319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-03-20 |
| Last Update Date | 2020-03-20 |