| NPI | 1861185811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA L RYAN Provider Recruiting & Credentialing 304-263-4999 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-05-26 |
| Last Update Date | 2023-05-26 |