| NPI | 1023457389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTAL LEANN FULMER Revenue Integrity Manager 803-395-4248 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2022-11-09 |