| NPI | 1730691858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONY RITTER Credentialing Specialist 740-773-4366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2019-07-05 |