| NPI | 1689669855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN R. SCHULTZ Executive Director 304-469-2905 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: WV 1036-9138) |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2023-10-09 |