| NPI | 1215462742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA WILLARD Owner 843-360-9491 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 4859) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2017-04-21 |