| NPI | 1316218670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON A KENNEDY Owner 843-737-5206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 24910) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: SC 24910) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2013-07-14 |