| NPI | 1912554353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THELISA SULTON Owner 803-404-7418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207KA0200X Allergy & Immunology, Allergy |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2020-02-02 |