| NPI | 1720672009 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARETHA R JONES CEO 843-722-4112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-10-19 |