| NPI | 1568492874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEILA P. GRISWOLD Office Manager 803-951-2750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC SC20418) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2012-11-29 |