| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 10 Bib Way, Anderson, South Carolina |
| Authorized Official Name and Position | Jon Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5500 Maryland Way Ste 400 Brentwood TN 37027-7048 Ph: () - | 10 Bib Way Anderson SC 29626 Ph: (864) 332-1793 |
| NPI Number | 1952808974 |
|---|---|
| Provider Enumeration Date | 04/06/2018 |
| Last Update Date | 08/23/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952808974 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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