| NPI | 1912964479 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAUNDRA WALLACE Administrator 803-435-2529 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 13275) |
| Additional Taxonomies | 207RC0000X Internal Medicine Cardiovascular Disease (Licence: SC 20345) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-08-22 |