| NPI | 1942669981 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES OUTZ Owner 864-986-5665 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: SC 23843) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2022-03-28 |