| NPI | 1366015513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L RYAN Provider Recruiting Manager 304-263-4999 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-07-23 |