| NPI | 1407202112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOM ROUSE Practice Manager 843-799-0642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: SC G20091) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2016-05-11 |