| NPI | 1497244412 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA J DAVIDSON-BENNETT Credentialing Specialist 304-438-6188 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2018-05-04 |