| NPI | 1063190510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL LYNN BLANKENSHIP Lead Credentialing Specialist 304-696-1636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2023-08-10 |