| NPI | 1396465043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABIA ONI MCMULLEN CEO 843-817-1744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171400000X |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine |
| 261QH0100X Clinic/Center Health Service | |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2022-09-01 |