| NPI | 1053524934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY KEITH SANTANA Co Owner 843-744-1447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC OTP063) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2020-08-22 |