| NPI | 1780196592 |
|---|---|
| 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 | 2017-11-02 |
| Last Update Date | 2017-11-02 |