| NPI | 1740450089 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE DIANNE RAY Credentialing Specialist 304-757-6999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2022-05-24 |