| NPI | 1215996046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM D. WILSON Physician 803-799-0201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: SC 12953) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2008-09-09 |