| NPI | 1073546875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DELENA STOUT Business Manager 843-492-2751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: SC ASF062) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-12-10 |