| NPI | 1154511418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHESTER L FERGUSON Owner 803-408-0965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center, Community Health (Licence: SC 958) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2008-11-18 |