| NPI | 1508287509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN GASNEL Md 803-648-0874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: SC 12145) |
| Enumeration Date | 2013-12-18 |
| Last Update Date | 2013-12-18 |