| NPI | 1265440705 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | YOHANNES NEGASH President 803-256-6828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |