| NPI | 1225331119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFAN MONTGOMERY CEO 803-269-4965 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: SC 27277) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |