| NPI | 1902083058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE LEONARA BAER Provider 843-559-1938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: SC RHC153) |
| Enumeration Date | 2008-01-30 |
| Last Update Date | 2012-12-06 |