| NPI | 1609815562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENNA LYNN Office Manager 864-269-4416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 19467) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 28639) |
| 208VP0000X (Licence: SC 19980) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 20828) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2018-07-30 |