| NPI | 1629448964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY DOUGLAS Fnp/ Primary Care Provider 864-423-3561 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MA RN2299504) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-09-29 |