| NPI | 1346113859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMI NICOLE DYBIK Authorizing Official 843-814-5177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2025-09-29 |
| Last Update Date | 2025-09-29 |