| NPI | 1912113317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA DEAN-BATES Office Manager 803-233-3199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: SC 5836) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2008-03-06 |