| NPI | 1811751043 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID DWIGHT BUCKLAND Owner 803-412-4720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-08-29 |