| NPI | 1376961631 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH GRANT Owner 864-968-2310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: SC 33418) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2014-04-03 |