| NPI | 1528771086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SADIE HOLMES Credentialing Administrator 843-488-6364 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2024-07-05 |