| NPI | 1518513795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY D BELTON Owner 803-223-9193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 251S00000X |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |