| NPI | 1548094808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN CORDIAL Credentialing Manager 606-886-8572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-08-29 |