| NPI | 1265696439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK WAYNE CLEMENZ Owner 803-359-7434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: SC MD5755) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2008-07-16 |