| NPI | 1891141578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN E FASSLER Medical Director 803-517-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: NC 200200218) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |