| NPI | 1124218920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISAAC SHEPPARD FUNDERBURK CEO 803-534-6550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: SC 2007-0000207) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2007-07-27 |