| NPI | 1053489443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID KRISTINE NIVENS Office Manager 843-705-7471 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 18439) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-12-31 |