| NPI | 1972980621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN M LEWIS CEO 843-857-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2016-06-15 |