| NPI | 1013396027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANIA DEJESUS Owner 843-729-8269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC LIC-1-15-126877) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: SC MDO.1175DO) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |