| NPI | 1437279122 |
|---|---|
| Doing Business As | PROVIDENCE NORTHEAST FAMILY CARE |
| Entity Type | Organization |
| Authorized Contact | ANGELA HAITHCOCK Project Manager 803-865-4780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2012-02-06 |