| NPI | 1184783284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANGELA KAY CRISWELL Business Office Director 843-663-1013 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 122300000X Dentist | |
| 1041C0700X Social Worker, Clinical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2014-12-09 |