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 |