| NPI | 1053683359 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE JONES-MARTIN Practice Administrator 803-807-9533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 33753) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-11-05 |