| NPI | 1538211339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BYRON JACKSON Owner 803-790-7200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: SC SC519) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-11-16 |