| NPI | 1275732422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY L BOURGEOIS Office Manager 803-534-0042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: SC 15347) |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2013-11-07 |