| NPI | 1710431150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA J FOWLER Owner 803-517-2122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: SC 4886) |
| Additional Taxonomies | 251S00000X (Licence: NC C004973) |
| Enumeration Date | 2016-08-14 |
| Last Update Date | 2016-11-04 |