| NPI | 1871872184 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE DIANNE RAY Credentialing Specialist 304-757-6999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: WV 2256-9525) |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-05-24 |