| NPI | 1710356464 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | KIMBALE LANETTE MACK Owner 803-764-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2015-09-23 |