| NPI | 1417317264 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY B WILLARD Practice Manager 803-765-2090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: SC 2580) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-03-07 |