| NPI | 1639458672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN M LEWIS CEO 843-857-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2012-03-21 |