| NPI | 1083961114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERDELL F HAYGOOD Office Manager 803-531-2722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC 0646) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2012-09-21 |