| NPI | 1023052354 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONJA WILLIS Insurance Specialist 843-692-2149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2010-07-21 |