NPI | 1205065828 |
---|---|
Entity Type | Organization |
Authorized Contact | STANTRENETTA AKEYA HARROLD Advanced Practice Registered Nurse 843-761-8282 |
Organization Subpart ? | No |
Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: SC 3810) |
Enumeration Date | 2009-07-02 |
Last Update Date | 2009-07-02 |