| NPI | 1629457650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER HODGE Practice Administrator 803-779-3263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: SC 13894) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2021-12-13 |