| NPI | 1205256732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY L. PHILLIPS President 803-309-1275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-26 |