| NPI | 1780319293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYNN ELTON CONNELLY Owner/Authorized Official 803-791-7043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2022-07-19 |
| Last Update Date | 2022-07-19 |