| NPI | 1306921010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GASNEL E BRYAN Physician 803-648-0874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: SC 12145) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |