| NPI | 1629553607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT TYLER BRADY Owner / Program Sponsor 864-616-5031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2022-01-21 |