| NPI | 1982248852 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOIS J MENKEN Credentialing Specialist 864-594-0175 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2020-01-07 |