| NPI | 1124315346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN WENNER Owner 843-629-8893 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2011-07-08 |