| NPI | 1013570910 |
|---|---|
| Other Name | LIFESTYLE CLINIC OF SELF MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | MATTHEW T LOGAN President And CEO 864-725-4253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2021-12-14 |