| NPI | 1316331127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CEDRICK MCDONALD Owner 803-547-2280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 4382) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-03-19 |