| NPI | 1336276112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH GOLD Practice Manager 843-681-9099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 21342) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 16961) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2020-08-22 |