| NPI | 1669923538 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORA L POTASNIK Credentialing COO Rdinator 304-317-7275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2023-07-25 |