| NPI | 1700830254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS L. TIEDT President 803-286-6922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: SC 27304) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-03-16 |