| NPI | 1366786485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH DANIEL FARR Medical Director 843-842-2020 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC DO 985) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |