| NPI | 1518979202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPHAEL MENSAH CARR Executive Director 843-546-6081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-04-10 |