| NPI | 1811586936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ASHWORTH Credentialing Specialist 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| 261QR1300X Clinic/Center Rural Health | |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2023-05-02 |