| NPI | 1811969918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA ELAINE REID Owner 803-400-1201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: SC 15941) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 15941) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2020-08-22 |