| NPI | 1376528950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORRAINE VERONICA TYLER Practice Administrator 843-723-6426 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: SC 7706) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2020-08-22 |