| NPI | 1366890295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M FIELDS Owner 803-361-7262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: SC 17854) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: SC 17853) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-01 |