| NPI | 1003058744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN BOTT Medical Director 803-325-9010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: SC ASF-0113) |
| Enumeration Date | 2009-03-26 |
| Last Update Date | 2023-03-07 |