| NPI | 1104130376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAREY MOLIN GULLY Owner 864-888-4464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: SC 261QR1300X) |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2010-07-30 |