| NPI | 1184814311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS F MACMILLAN Owner 864-984-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 0991) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2007-07-25 |