| NPI | 1790925634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KHADIJAH H ALLEN Podiatrist 803-937-5876 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: SC 598) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2010-03-15 |