BASTIAN -- Some patients at Bland County Medical Clinic walk in right off the Appalachian Trail.

Foot problems, infections and even spider bites have all brought hikers in, said Susan Greever, the clinic's executive director.

One elderly woman hiker, who had recently had some toes surgically removed because of diabetes problems, stopped off to have her stitches removed, Greever said.

The clinic was established in 1979 mainly for people in Wythe and Bland counties. But it brings in patients from as far off as Tazewell and Giles counties in Virginia and Mercer County, W.Va., she said.

All this has created a space crunch in the building, which is 4,280 square feet not counting an on-site pharmacy. Its number of patient visits has gone from about 6,000 in 2000 to more than 13,000 in 2005.

One employee works out of a supply room. About half a dozen are assigned to what had been a conference room. A doctor makes telephone calls sitting in a hallway.

The clinic includes two physicians, five nurse practitioners and a staff of 25, all of whom are looking forward to a planned expansion that will more than double their space. "We're kind of falling over top of one another right now," Greever said.

About a month ago, Rep. Rick Boucher, D-Abingdon, announced a $1.2 million low-interest Rural Development loan to be used for an expansion. Along with money raised, donated or secured from other agencies, that still left the project in need of about $700,000 for completion.

This week, the county board of supervisors accepted a $700,000 Community Development Block Grant to complete the needed funding.

The clinic will be expanded to 12,133 square feet. The number of examination rooms will be doubled to 16, and a mental health office will be added along with more office space, an expanded nurses station, an educational training and conference room and a rehabilitation office for occupational and physical therapy.

The project should be complete a year after construction starts, making the clinic able to serve 18,000 patients a year.

Laboratory, X-ray and EKG facilities are already on the premises. There is an electronic link with the University of Virginia Hospital, with video capabilities so patients at the clinic can literally see, and be seen by, doctors in Charlottesville. "So it's a one-stop shop. You can come here and get anything done," Greever said.