| NPI | 1336528504 |
|---|---|
| Doing Business As | CHICHORA LIFE CENTER |
| Entity Type | Organization |
| Authorized Contact | REUBEN PETTIFORD CEO 843-722-4112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-05-21 |