| NPI | 1780640623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY AMERSON Billing Manager 843-658-3005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: SC 21527) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: SC 21527) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2020-08-22 |