| NPI | 1023157575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA GILLUM Coder 843-300-3588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2014-10-28 |