| NPI | 1760991921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL B. SHEALY Authorized Official 803-331-8997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2024-09-06 |