# PRIME CARE OF THE LOWER PEE DEE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437692407
- **Authorized official:** DR. TYRONE DELMAR WALLACE DC (OWNER)
- **Authorized official phone:** (843) 394-8274

## Contact information

- **Practice address:** 263 KELLEY ST STE 100, LAKE CITY, SC 29560-2472
- **Practice address phone:** (843) 394-8274
- **Practice address fax:** (843) 394-1604
- **Mailing address:** 263 KELLEYST STE 100, LAKE CITY, SC 29560
- **Mailing address phone:** (843) 394-8274
- **Mailing address fax:** (843) 394-1604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | SC 1873 | SC | Yes |

## Other

- **Enumeration date:** 11/23/2016
- **Last updated:** 11/23/2016