| NPI | 1205233442 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL M LONG Owner 843-681-5305 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 8178) |
| Additional Taxonomies | 208D00000X General Practice (Licence: SC 8178) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2015-07-30 |