| NPI | 1902393549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD HARGRAVE Owner 803-419-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-08-14 |