| NPI | 1184423592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL G WESTBROCK Provider Enrollment Supervisor 740-374-1581 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-06-05 |