| NPI | 1114291515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN JORDAN Credentialing 843-408-4170 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: MO 2002002274) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |