| NPI | 1174795900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GORDON REESE WEIGLE Owner 803-533-0091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: SC SC8901) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2008-04-02 |