NPI | 1811752090 |
---|---|
Entity Type | Organization |
Authorized Contact | RACHEL LYNN BLANKENSHIP Credentialing Manager 304-429-1088 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
Enumeration Date | 2024-02-16 |
Last Update Date | 2024-02-16 |