| NPI | 1770121972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROXANN CORDIAL Credentialing 606-886-8572 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2019-12-18 |