| NPI | 1164690822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE ANN MITTLEBRONN Billing/ Credentialing 843-881-2265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SC 22838) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2011-05-10 |