| NPI | 1114277050 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA L POTASNIK Credentialing 304-317-7275 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: WV 2274-1060) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2024-01-19 |