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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. LATIANA MCDANIEL (CEO)
(864) 310-8717
Entity
Organization

Contact information

Practice address
2601 READ ST STE I7, COLUMBIA, SC 29204-7861
(864) 310-8717
Mailing address
18 BERRYHILL RD APT 17F, COLUMBIA, SC 29210-6427
(864) 310-8717

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary

Other

Enumeration date
07/08/2015
Last updated
07/08/2015
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