| NPI | 1194116707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISSA C LARA CEO 843-412-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: SC 36116) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2015-02-18 |