| NPI | 1871701029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM T ODOM President 803-724-7495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2021-04-23 |