| NPI | 1134746555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARYN RAE Chief 843-876-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2022-09-23 |