| NPI | 1164690947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAROLD WILLIAM STITES Owner 843-720-8495 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: SC 20522) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |