Organization
VITAL ENERGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HIMA N DALAL OT (OWNER)
(803) 233-3049
Entity
Organization
Contact information
Practice address
1812 AUGUSTA HWY STE L, LEXINGTON, SC 29072-1915
(803) 233-3049
(203) 233-9201
Mailing address
121 CLEARVIEW DR, COLUMBIA, SC 29212-8304
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
2626
SC
Other
Enumeration date
09/14/2007
Last updated
09/14/2007
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