| NPI | 1710958210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON DICKSON Billing Manager 864-647-1820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 11770) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2025-10-29 |