| NPI | 1538766712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA D GILLIARD CEO 843-990-7993 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2022-06-22 |