| NPI | 1780742825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERNEST JAMES STANLEY WARDLAW CEO 843-335-8291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2023-09-29 |