| 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 |