NPI | 1376958546 |
---|---|
Entity Type | Organization |
Authorized Contact | PREZILLIC DANIELS Owner/Counselor 843-661-6030 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: SC 5468) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: SC 5468) |
Enumeration Date | 2014-06-26 |
Last Update Date | 2014-06-26 |