| NPI | 1124743331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL COLLINS JACKSON Owner/Provider 864-380-8946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2022-10-10 |