| NPI | 1730352857 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE KNIGHT DISHER Credentialing Manager 803-773-5227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 3004568) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2021-03-22 |