| NPI | 1205002888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW T CLARK Physician/Owner 803-441-8648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: SC 28227) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2013-04-18 |