| NPI | 1609640861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONDRE WILSON CFO 803-531-6952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2024-05-29 |