| NPI | 1083055081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA J DESHONG COO 301-678-5187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: WV 2291-3644) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2014-02-21 |