| NPI | 1508950494 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDIA M. TARLTON Office Manager 803-254-2786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: SC 23437) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-02-12 |