| NPI | 1083944243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORIANO JARON GILLIAM Executive Director 803-524-9516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2010-01-11 |