| NPI | 1922487610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLIE G. WILSON Senior Vice President 803-210-9554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: SC 261QR405X) |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-05-27 |