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