| NPI | 1972346062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW STAUB Chief Executive O Fficer 803-730-8910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-06-17 |