| NPI | 1770517658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE VALENTINE Ubo Manager 843-794-6071 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-05-30 |