NPI | 1386751337 |
---|---|
Entity Type | Organization |
Authorized Contact | SANDRA L. POWELL President 843-881-0007 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: SC 10505) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2020-08-22 |