| 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 |