NPI | 1144472119 |
---|---|
Entity Type | Organization |
Authorized Contact | AVANGELA KAY CRISWELL Business Office Director 843-663-8017 |
Organization Subpart ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
Enumeration Date | 2008-10-21 |
Last Update Date | 2012-05-31 |