| NPI | 1417195553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER J GREEN Owner 843-757-5559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: SC 2999) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2021-01-28 |