| NPI | 1083831770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | F KIRK PETERSON Administrator 803-779-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2007-11-05 |