| NPI | 1376916759 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE INGRAM-SMTH Licensed Independent Practitioner 803-476-2533 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: SC 10827) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2015-11-05 |