| 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 |