| NPI | 1730740333 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RANDEL Business Office Manager 803-366-7443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2020-05-12 |