| NPI | 1104620384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA JOHNSON Credentialing Officer 304-469-2905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-04-04 |
| Last Update Date | 2025-04-04 |