| NPI | 1831275171 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIM CROFTON Executive Director 304-448-2101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WV 031000) |
| Enumeration Date | 2006-10-30 |
| Last Update Date | 2019-02-28 |