| NPI | 1083809958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL ANTIONETTE GRANT Owner 843-509-5848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: SC 25971) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2007-09-13 |