| NPI | 1861874430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SADIE HOLMES Credentialing Administrator 843-488-6364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2024-07-05 |