| NPI | 1518217389 |
|---|---|
| Doing Business As | IVY PARK FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | WADE REYNOLDS President 803-785-4555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: SC 0417) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2012-09-19 |