| NPI | 1174800387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | A NICHOLAS DEPACE Sole Proprietor 803-358-9410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 828) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2011-11-16 |