| NPI | 1598119885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN L SCOTT Owner 864-582-3456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: SC 6850) |
| Enumeration Date | 2016-04-22 |
| Last Update Date | 2016-05-03 |