NPI | 1366797375 |
---|---|
Entity Type | Organization |
Authorized Contact | NICHOLE OLSON Practice Manager 843-849-1300 |
Organization Subpart ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC TL1798) |
Enumeration Date | 2012-07-16 |
Last Update Date | 2012-07-16 |