NPI | 1104228311 |
---|---|
Entity Type | Organization |
Authorized Contact | VANESTER SEABROOKS RAVENELL Business Manager 803-854-4106 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization |
Enumeration Date | 2014-09-18 |
Last Update Date | 2014-09-18 |