| NPI | 1972960722 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL THACKER Sole Member 803-788-6400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: SC 00627) |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2016-01-25 |