| NPI | 1134265325 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARYN RAE Director 843-876-1344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-08-22 |