| NPI | 1619503422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY L RAVEAUX CEO 304-797-7733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |