| NPI | 1679223390 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA J BENNETT Credentialing Specialist 304-438-6188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-03-25 |
| Last Update Date | 2023-02-09 |