| NPI | 1801036959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW ALAN NELSON Doctor 803-345-3466 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 3420) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2009-03-03 |