| NPI | 1700014180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA WALLS CEO 304-897-5915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2020-01-29 |