| NPI | 1376958546 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PREZILLIC DANIELS Owner/Counselor 843-661-6030 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: SC 5468) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: SC 5468) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2014-06-26 |