| 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 |