| NPI | 1700446929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY-BETH BRUBECK CFO 304-525-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-06-19 |