| NPI | 1194111468 |
|---|---|
| Doing Business As | LIBERTY HIGH SCHOOL WELLNESS CENTER |
| Entity Type | Organization |
| Authorized Contact | DORA L POTASNIK Credentialing 304-587-2541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2015-04-13 |