| NPI | 1467822288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLORY MACE Owner 864-553-3154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: NC MHL-045-122) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2019-06-26 |