| NPI | 1194710426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLON HUNTER CEO 864-582-2817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2020-05-18 |