| NPI | 1437385788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN G WIDENHOUSE Owner 843-856-8398 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 200096) |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2017-03-09 |