| NPI | 1235108721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANON WELCH HONNEY Member 843-406-4948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: SC 22489) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-08-22 |