| NPI | 1407394646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARISSA JOHNSON Credentialing 304-469-2905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2023-10-09 |