| NPI | 1003614900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TJUANA SEIDL Director 803-646-0126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2025-03-05 |
| Last Update Date | 2025-03-05 |