| NPI | 1669298014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANTINA MAYO CEO 843-448-6034 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2025-01-21 |