| NPI | 1013226448 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARONDA D GORDON Owner 803-603-9218 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2010-10-04 |