| NPI | 1669968152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LASHONDA S TYLER Owner 803-302-8205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC BL015940-07-2018) |
| Enumeration Date | 2018-07-08 |
| Last Update Date | 2018-07-08 |