| NPI | 1780968347 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH JACKSON CEO 803-779-0169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 5286) |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-10-31 |