| NPI | 1780224352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ATHELSTANE SERAPHIN Coi 912-527-1130 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2020-01-13 |