| NPI | 1508958216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLAJIDE A. BALOGUN Medical Director 803-408-0225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 20381) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 20381) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-03-10 |